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Insurance issues dealing with CMS to private insurance.

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Optum Health PCP Referral Requirement and Direct Access States
Wednesday, 12 March 2014

Many of our members have received letters from Optum Health introducing their new products Compass and Navigate. Does the requirement to obtain a referral from a PCP before seeking chiropractic services apply to Florida?

 

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ACA Advocacy Results in DC's Expansion of Coverage Under BCBS Federal Employees Plan
Friday, 20 December 2013
(From the ACA "Week in Review" of December 19, 2013)  Doctors of Chiropractic (DCs) will be listed equally with other types of physicians and will no longer have any limitations attached to their definition of physician under the 2014 Blue Cross and Blue Shield (BCBS) Service Benefit Plan, as authorized by the Federal Employees Health Benefits (FEHB) law. 
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Reminder: Federal BCBS Does Not Cover Massage By an LMT
Monday, 18 November 2013
Although BCBS of Florida will reimburse DCs for massage by an LMT if the LMT is an employee under direct supervision, BCBS Federal does not cover massage rendered by an LMT.   The Federal BCBS policy clearly states that physical therapy services, which include massage or manual therapy, are not covered when rendered by an LMT.
 
Affordable Care Act FAQs
Wednesday, 02 October 2013

Q: Are chiropractors required to provide written notice to employees about the Health Insurance Market Place by October 1, 2013 and are there fines or penalties for failure to do so?

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Aetna Agrees to Allow CMT+97140
Friday, 16 August 2013
(From an 08/14/2013 ACA Insurance Relations Dept. Update) Aetna instituted a policy effective March 1st stating that Manual Therapy (CPT code 97140) would not be recommended for separate payment when billed with Chiropractic Manipulative Treatment (CMT). It also stated that Modifiers 25 and 59 would not override to allow reimbursement. ACA first obtained agreement that claims could be appealed after being denied, with submission of proper documentation showing 97140 was performed to a separate region. After further discussion, ACA and Aetna reached a mutually beneficial solution allowing documentation to be submitted with the initial claim for review, so that there is no need for denial - a true example of successful cooperation between ACA and insurance companies. In this way, both Aetna and providers only handle the claim once. At this time, Aetna has changed its computer system to allow for documentation to be submitted on medically necessary claims that demonstrate that 97140 was performed on the same date of service as CMT, and that 97140 was performed in a region other than the region in which the CMT was performed. 

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